Spring 2016 Home Care Section Bulletin

Spring 2016 Home Care Section Bulletin

Kimberly Wiles, BS, RRT, CPFT
VP of Respiratory Services
Klingensmith HealthCare
Kittanning, PA 16201-1922
(724) 763-8889, ext. 5220
Fax: (724) 763-4284
Email: kwiles@klingshc.com

Past Chair
Greg Spratt, BS, RRT, CPFT
Director of Clinical Marketing
Oridion Capnography
Needham, MA
Home Office:
3144 CR 193
Philadelphia, MO  63463
Office: (573) 439-5804
Mobile: (857) 919-2947
Email: gspratt@marktwain.net

Zachary Gantt, RRT
104a West Court Square
Livingston, TN 38570-1864
(931) 261-9302
Email: zgantt@hotmail.com

In this issue:

Notes from the Chair

Kimberly Wiles, BS, RRT

Another AARC Congress is behind us, and what a way to close out 2015. It was clear that home care was a focus at this event. There were 25-plus lectures focusing on the post-acute care setting, as well as a pre-Congress session dedicated to oxygen therapy in the home. It was a great representation of how the respiratory therapist plays a vital role in caring for patients in the home setting. Save the date for the 2016 Congress — October 15-18 in San Antonio, TX!

Dr. Kent Christopher was the recipient of the Thomas L. Petty MD Invacare Award for Excellence in Home Respiratory Care. Dr. Christopher started his career as a respiratory therapist and continues to promote the respiratory therapy profession. His passion for our profession is second to none. His pulmonary career has led him in many different directions, but all pathways have converged on quality patient care and advocacy for the respiratory therapist. He has been extremely supportive of the Home Care Section and has been instrumental in moving the section into the future through his dedication and compassion. Congratulations to Dr. Christopher!

We had record attendance at the section meeting, which is a great sign that our section members understand the importance of uniting as a group. It was decided that the Section Bulletin would be published twice a year vs. four times per year. An online meeting will be held to discuss current issues and trends in place of the two Bulletins. AARC Director of Regulatory Affairs Anne Marie Hummel gave the group a legislative update on the ventilator policy as well as the Medicare Telehealth Parity Act. The AARC continues to lobby and advocate on our behalf. As a group we will continue to strive to define home care competencies and will begin rolling out webinars soon, with an eye toward developing an educator course on home care competencies down the line.

2016: Where Do We Go from Here?

Kimberly Wiles, BS, RRT, CPFT

We are seeing a paradigm shift in health care. Focus is being placed on preventing readmissions by transitioning patients safely and effectively into their home setting.

It is clear that successful transitions are accomplished through work that takes place inside the four walls of the hospital, work that takes place outside the four walls of the hospital, and perhaps most importantly, bridging the gap between the two.

Patient-focused care and self-management of the respiratory patient begins and ends with the respiratory therapist. As respiratory therapists, we are positioned to carry out this role through our understanding and utilization of best practices. But respiratory therapists who work in the hospital or physician’s office must understand the obstacles and limitations to care when transitioning patients.

The home care respiratory therapist possesses knowledge that is vital to the success of the transition. One of our most important roles is to educate our peers on how these obstacles may impact the safe and effective transition to home. For example, complex insurance criteria must be met prior to receiving care in the home. This may limit or delay care. It is important to understand what is required so that testing can be ordered and completed in a timely manner.

Another example lies in the differences that exist in technology. Does the acute care RT, case manager, and/or physician understand that when oxygen is ordered at 2lpm, that 2lpm is not an accurate correlation to the oxygen devices used in the home? Do these hospital-based clinicians know that if a patient needs oxygen via a tracheostomy we are limited and cannot achieve high FIO2s?

As home care therapists, these are the struggles we are faced with. How do we overcome some of these obstacles? The first step is education. We need to get the message out that many differences exist between caring for patients inside the four walls of the hospital and caring for patients outside of the four walls of the hospital. When RTs are involved in the transition or “hand off,” it is imperative that they understand what is being ordered in the home and whether or not it is achievable. They are the first discipline to address the challenge of patient empowerment.

The respiratory therapist is positioned well going into the future. But we have to break down the walls and silos and look at the comprehensive care of the patient. Hospitals are pressured to cut costs and are being penalized for 30-day readmissions, home care RTs are being eliminated across the country due to significant reimbursement cuts, physicians aren’t able to spend as much time with their patients, and more patients want to stay in the comfort of their homes.

How do we maintain quality patient care in this environment? It is clear that the future of health care lies in the post-acute care arena (i.e. home care, skilled nursing, physician’s office, etc.). Everyone in our profession must be ready to make the shift and understand the challenges in the home care environment.

Vitality vs. Vitals

Zach Gantt, RRT, and Kimberly Wiles, BS, RRT, CPFT

The pace of change in home respiratory care is speeding up as payers look for new solutions for chronic respiratory care after a hospitalization and for their members with COPD. New analytic claims models are being used to identify disease progression and ultimately develop risk profiles to encourage early engagement with patients.

Unfortunately, while these population health models are targeted at understanding the cost/hospitalization profiles of the COPD population, payers are struggling to develop effective post-acute pathways. Once a high-risk patient is identified, connecting that patient to a provider network with respiratory expertise requires innovative protocols and monitoring, payment for respiratory services, and new relationships with respiratory service providers. Accelerating the gap in care are new global payment incentives such as Accountable Care Organizations, bundled episodes of care, and preferred provider networks.

The opportunity is emerging for respiratory therapy to distinguish itself not only as a core care provider for skilled nursing, home health, and hospice, but also as a standalone respiratory population health care provider. The respiratory expertise gap in skilled facilities and home health can be illustrated by the simple assessments out there today that ignore self-management skills, O2 titration during activity, medication best practice standards vs. reconciliation, and advanced dyspnea measures such as the COPD Assessment Tool (CAT). Implementing these measures and integrating the new GOLD stages into risk metrics are essential to elevating respiratory outcomes and point to the payers’ need for specific and specialized respiratory management programs.

Innovative respiratory care protocols can shift the traditional home care practice from just assessing vital signs to promoting vitality in the home. Vitality is the patient’s goal, and our methods of improving functional performance should be centered on greater activity capability, dyspnea and anxiety lowering skills, a shift from short-term drug therapy to long-term exacerbation control, and engaging the patient in managing his symptoms.

Tele-monitoring systems have been touted as a way to gain control of readmissions. But tele-monitoring systems that simply collect blood pressure, heart rate, weight, and resting SpO2 (via a wired oximeter) require the patient to attach the sensors on a daily basis in order to record a value, a routine for which compliance declines over time. Instead of solely relying on vitals, respiratory therapists can focus on vitality by building ambulatory capability, fostering ADL accomplishment, and measuring symptom control via tools like the CAT. Monitoring patients in the home should move from wired sensing to passive/wireless activity sensing that, by nature, has higher compliance and focuses on functional capabilities.

As population health initiatives expand, so too do simple solutions that offer nursing checklists, non-expert call centers, and blanket protocols. But as the challenges of providing respiratory care are recognized, we can counter that direction by promoting and innovating respiratory home care with individualized patient protocols that demonstrate the value of contracting for high touch RT services that result in fewer 30 day and 12 month readmissions.

By improving our patients’ understanding of their self-management skills and building their confidence in their physical capabilities we can help them reestablish their independence better than any other therapy discipline — and be recognized by payers as the answer to their population health goals.

Section Connection

Recruit a new member: Know an AARC member who could benefit from section membership? Direct them to section sign-up. It’s the easiest way to add section membership to their overall membership package.

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Next Bulletin deadline: Fall Issue: August 1.